title: Operative versus non-operative treatment for two-part surgical neck fractures of the proximal humerus.
abstract: BACKGROUND
  Aim of this study was to evaluate outcomes of operative as compared to conserveative treatment for two-part humerus fractures at the surgical neck.
  
  
  METHODS
  Data from a prospective multi-centre cohort study on four treatment options (conservative treatment and three implants, i.e. LPHP, PHILOS and PHN) for proximal humerus fractures were evaluated in this post hoc analysis. All patients with two-part fractures of the surgical neck (AO types A2, n = 54 and A3, n = 110) were identified and included for the analysis. All operatively treated patients were gathered and compared to those receiving conservative treatment. Primary outcome parameters were pain, range of motion and absolute and relative Constant scores at 3, 6 and 12 months following injury and coronal plane alignment at 12 months.
  
  
  RESULTS
  Operative (n = 133) and non-operative (n = 31) groups were comparable with regard to all parameters assessed including mean age (62.9 vs. 65.6, P = 0.479), gender (27 vs. 29 % male, P = 0.826) and fracture distribution (65 vs. 77 % A3 type, P = 0.207). 26 of the 31 conservatively treated and 103 of the 133 operatively treated patients (84 and 77 %, respectively) were available for final follow-up. There was a continuous improvement for all outcome parameters in both treatment groups (P < 0.001). Operative treatment resulted in a more effective reduction of pain at 3 months (51 vs. 76 % reporting pain at fracture site, P = 0.03) and a reduction of coronal plane malalignment. Both range of motion and Constant scores were, however, comparable in both groups at all follow-up visits. Relative and absolute Constant scores were generally excellent at final follow-up (74 vs. 74, P = 0.528 and 89 vs. 91, P = 0.494, respectively).
  
  
  CONCLUSIONS
  Both non-operative treatment and operative treatment using modern implants (LPHP, PHILOS and PHN) can be considered safe and effective treatment options for two-part fractures of the proximal humerus. Operative treatment may result in better range of motion and reduced pain in the early postoperative course of treatment.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Freiburg University Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany, oliver.hauschild@uniklinik-freiburg.de.
authors.forename: O
authors.initials: O
authors.lastname: Hauschild
authors.forename: G
authors.initials: G
authors.lastname: Konrad
authors.forename: L
authors.initials: L
authors.lastname: Audige
authors.forename: P
authors.initials: P
authors.lastname: de Boer
authors.forename: S M
authors.initials: SM
authors.lastname: Lambert
authors.forename: R
authors.initials: R
authors.lastname: Hertel
authors.forename: N P
authors.initials: NP
authors.lastname: Südkamp
mesh_terms: D000368:Aged; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods; D006305:Health Status Indicators; D006801:Humans; D007103:Immobilization / Q000379:methods; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012784:Shoulder Fractures / Q000601:surgery / Q000628:therapy*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000502:physiology / Q000601:surgery; D016896:Treatment Outcome